MEDICARE: PURE CLARITY COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1457851891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE CLARITY COUNSELING, LLC

Provider Business Mailing Address
First Line	:	2001 E LOHMAN AVE STE 110
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3197
Country	:	US
Telephone Number	:	575-520-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 E LOHMAN AVE STE 110
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3197
Country	:	US
Telephone Number	:	575-520-0887
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	CRYSTAL M TAPIA
Credential	:	LCSW
Telephone Number	:	575-520-0887

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	09/21/2020

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